Provider Demographics
NPI:1043437650
Name:MUSTIAN, LINDA C (MS, CCC-SP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:C
Last Name:MUSTIAN
Suffix:
Gender:F
Credentials:MS, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 HAWK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2985
Mailing Address - Country:US
Mailing Address - Phone:303-530-5680
Mailing Address - Fax:
Practice Address - Street 1:1208 HAWK RIDGE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2985
Practice Address - Country:US
Practice Address - Phone:303-530-5680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0285472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43173365Medicaid